Credentialing Specialist

Minneapolis, Minnesota
Jan 25, 2023
Mar 25, 2023
Employment Status
Full Time
Health Care that Starts with You!

Join a truly mission-driven organization! Independent, nonprofit UCare is recognized as one of the Minnesota's leading health plans. We provide more than 600,000 members across Minnesota and western Wisconsin with the health coverage plans and services they need to maintain and improve their health. The innovative coverage we create makes a difference for Medicare-eligible individuals, individuals and families enrolled in Minnesota Health Care Programs, such as MinnesotaCare and Medical Assistance, and disabled adults with special health care needs.

UCare is growing in size, membership, products, geographic coverage, and employees. We're an organization that's going places. Be part of a team that cares about you, be part of UCare.


Enter a highly collaborative environment where people are truly engaged, and feedback is valued. You'll enjoy a competitive salary and benefits, as well as a host of other perks, including a nationally recognized wellness program, and a bright, open, award-winning office space in Northeast Minneapolis just minutes from major freeways and retail centers.

At UCare, we welcome and employ a diverse employee group committed to meeting the needs of UCare, our members, and the communities we serve.




UCare offers Medicare, Medicaid, Individual and Family health plans - powered by the hardest working people in the industry. Our people powered teams de-complicate, advocate and always go the extra mile to help our members. We serve with integrity, compassion and commitment to do right by members, providers and government partners. Above all, we come to work excited to provide members a path for the best health of their lives.


Working at UCare is more than a career; it's a mission. A mission that defines us as professionals, unites us as an organization and shapes how we interact with our members and each other. Employees join UCare and stay because of the opportunity to have a purpose-driven job.

Our strong culture has established UCare as a Star Tribune Top 200 Workplace for 13 consecutive years since the awards program began. It's a culture that embraces innovative ideas, strategic partnerships, and exemplary customer and provider experiences. Working at UCare is being a part of a people powered team dedicated to making a real difference in the lives of our members and communities.


Work Location: Work from home

Position Description

This position is responsible to investigate, and primary source verify the credentialing and recredentialing applications in accordance to NCQA, CMS and MDH Standards for all contracted providers. Provide verbal and written communication to contracted providers to obtain compliant documents and approval dates. Prioritize and organize work in order to meet regulatory requirements.

• Conduct thorough investigation of the practitioner and facility credentialing applications to determine eligibility status as defined in UCare's Credentialing Plan.

• Maintain knowledge of current health plans and regulatory requirements for credentialing.

• Perform credentialing investigation and primary source verification for provider initial and recredentialing of assigned providers utilizing NCQA Standards and other federal and state regulatory requirements. Ensure timely verification to prevent any negative impact related to compliance or regulatory requirements.

• Maintain timely communication with external providers regarding the eligibility and credentialing decisions and/or related provider issues.

• Serve as a resource specialist for internal departments for daily issues related to provider credentialing activities.

• Identify administrative and professional issues that require additional investigation and evaluation, validates discrepancies and ensures appropriate follow up with provider, Medical Director, and cross-departments. Prepares summary for Credentialing Committee Review, if applicable.

• Enter and maintain credentialing data following NCQA as well as state and federal requirements.

• Primary resource specialist for processing expedited files and credentialing projects.

• Demonstrate independent analytic problem-solving skills.

• Import credentialing applications into the credentialing database using the established integrative tools. Manually log the applications when system tools are unable to. Identifies system changes needed to better import data.

• Monitor the credentialing email for incoming initial and recredential reappointment applications and manually log into Cactus.

• Analyze and maintains provider data entered in the credentialing database to ensure accuracy for members in Find A Doc and directories.

• Provides analytical support to assist with operational decision-making.

• Other projects and duties as assigned.


High school or equivalent. Certified Provider Credentialing Specialist (CPCS) or Certified Medical Staff Coordinator Certification preferred.

Required Experience

Two years of experience in health care related environment, preferably in an insurance or HMO environment with exposure and familiarity with the process for providers. PC experience including spreadsheet, and word processing, preferably Microsoft Access, Excel and Word.

Preferred Experience

Experience in a clinic business office, insurance or HMO environment. Delegation of credentialing/recredentialing and/or credentialing/recredentialing experience.


The UCare difference is our people power - employees actively working on the behalf of our members to get them access to the health care they need. We value and respect each individual's ideas and contributions, and provide the freedom to grow both personally and professionally. We are centrally located, and offer onsite education, equipment and wellness resources, and a myriad of volunteer activities. If you're looking for an inclusive environment that celebrates your people power, helps you build on your strengths and gives you the opportunity to truly make a difference, we invite you to apply.

As an Equal Opportunity/Affirmative Action Employer, we welcome and employ a diverse employee group committed to meeting the needs of UCare, our members, and the communities we serve.

JOB POST DATE: 1/24/2023

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